5160-1-25
Interest on overpayments made to medicaid providers.

(A)
Except for medicaid contracting managed
care plans (MCPs), and nursing facilities and intermediate care facilities for
individuals with intellectual disabilities
(ICF/IID) rate recalculations performed in accordance with
sections
5165.41 and
5124.41 of the
Revised Code, any provider of services or
goods contracting with the Ohio department of medicaid
(ODM)
pursuant to Title XIX of the Social Security Act who, without intent, obtains
payment from the medicaid program in excess
of the amount to which the provider is entitled becomes liable for payment of
interest charged in accordance with this rule on the amount of the overpayment.
The interest rate charged is the average bank prime
rate in effect on the first day of the calendar quarter during which the
provider receives notice of the excess payment,as determined in accordance
with section
5164.60 of the Revised
Code. Interest payments shall
be calculated on the basis of simple interest.

(B)
Interest payments shall be charged on a
daily basis for the period from the date the payment was made to the date upon
which repayment is received by the state.

(1)
For any reasonable cost
basis, prospective payment basis, or other cost-related rate final settlement
issued by ODM, the "date payment was made" shall be ten days
from the date the final settlement is received by the provider as shown by the
U.S. postal service return receipt slip, with a notice of rights to appeal
pursuant to Chapter 119. of the Revised Code.

(2)
For audits conducted in accordance with
rule 5160-1-27 of the Administrative Code, the "date
payment was made" shall be the latest date a warrant or electronic funds
transfer (EFT) was issued to pay an item included in the random
sample.

(3)
For post-payment
reviews conducted in accordance with rule 5160-1-27
of the Administrative Code, the "date payment was made" shall be the latest
date a warrant or EFT was issued in payment of a claim that is included in the
review.

(D)
The "date
upon which repayment is received by the state" shall mean the following:

(1)
In the case of repayment by check or EFT,
the "date upon which repayment is received by the state" shall be the date the
repayment is date-stamped by ODM, the date the repayment is deposited as certified
mail with the U.S. postal service, or the date the EFT is deposited in the
state's account.

(2)
In the case of
repayment by one or more offsets implemented by the ODM claims
adjustment unit against future claims payments owed to the provider, the "date
upon which repayment is received by the state" shall be the date on which the
total amount of the overpayment is fully recovered.

(E)
ODM may waive interest when voluntary repayment
is made by a provider
before any notification by ODM that an overpayment has occurred.